Type I split cord malformation with an usual bony morphology

Variations in the configuration of the bony septum found in patients with split cord malformations are rare. We report the seemingly rare occurrence of a midline bony septum that ended posteriorly as a fully formed bony spinous process. We speculate that this variation is due to misplaced mesodermal cells associated with the primitive endomesenchymal tract during approximately the third week of foetal life. The clinician that manages these patients may wish to consider this rare morphology and avoid excessive manipulation of such a process, which could potentially injure an underlying hemicord

The most common anatomical sites of arterial injury in the extremities: a review of 75 angiographically-proven cases

The incidence of vascular injury has increased worldwide. In an attempt to quantitate the specific arteries most commonly involved in the extremities, we reviewed 75 patients with extremity trauma who were evaluated with angiography (DSA, digital subtraction angiography). The majority of these injuries were related to motor vehicle accidents (93.3%). The mean age of these patients was 28.16 ± 11.14 years, 94.7% of these patients being male. The ratio of upper to lower extremity arterial trauma was 12 to 86. A total of 99 arterial injuries were detected angiographically. Simultaneous injuries to two and three extremity arteries were identified in 13.3% and 9.3% of patients respectively. The most common arteries injured were the anterior tibial, femoral, peroneal, and popliteal arteries. Associated fractures were present in 86.7% of patients. These data may prove useful to the clinician who evaluates post-traumatic injuries of the extremities

An unusual muscle of the wrist with potential compression of the ulnar nerve

During routine cadaveric dissection of the upper extremity an unusual muscle was discovered arising from the tendon of the flexor carpi ulnaris and inserting into the muscle belly of the flexor digiti minimi. The muscle’s course was superficial to the ulnar nerve and artery in Guyon’s canal. We review the literature regarding such muscle variations and discuss the potential for compression of the ulnar nerve by such muscles

Accessory venous sinus of Hyrtl

Variations of the intracranial venous sinuses are important to the surgeon during intraoperative procedures and to the clinician during imaging interpretation. We report a male cadaver found to have a rare venous sinus variation. In all likelihood, this sinus corresponded to the rarely reported accessory venous sinus of Hyrtl. The sinus was approximately 5 mm in width and traveled from the sphenoparietal sinus anteriorly to the veins, draining into the foramen spinosum (i.e. the middle meningeal veins) posteriorly. No other variations or obvious pathology were identified intracranially or extracranially. Knowledge of such a venous variation may be of use to the clinician

Levator claviculae: a case report and review of the literature

The levator claviculae is an uncommon anatomical variant found in the posterior cervical triangle. In this report we present a 78-year-old man with this muscular variation, which was found during gross anatomical dissection. While sites of insertion and origin have been variable, in the present case the muscle originated from the left transverse processes of C3 and C4, and inserted onto the lateral third of the ipsilateral clavicle. Clinical considerations of this variant anatomy are of interest, as they may present in patients as a supraclavicular mass and may also mimic pathology on cross-sectional imaging

A rare variation of the posterior cranial fossa: duplicated falx cerebelli, occipital venous sinus, and internal occipital crest

Folds of the meningeal layer of the dura mater, the falx cerebri and tentorium cerebelli, traverse the vertebrate intracranial cavity and thus compartmentalise the brain. The falx cerebelli, another dural fold, is found in the posterior cranial fossa and attaches to the inferior aspect of the tentorium cerebelli and to the internal occipital crest. We present a case of a duplicated falx cerebelli, occipital venous sinus and internal occipital crest that was detected upon routine dissection of a male cadaver. Since haemorrhage of a dural venous sinus can be a fatal complication of posterior cranial fossa surgery, knowledge of venous sinus variations in this region may prevent unpredictable complications during intracranial procedures

Aortic bifurcation angle as an independent risk factor for aortoiliac occlusive disease

Recently, there has been interest in potential geometric risk factors that might result in or exaggerate atherosclerosis. The aortic bifurcation is a complex anatomical area dividing the high pressure blood of the descending abdominal aorta into the lower limbs and pelvis. The distribution of the bifurcation angle and any asymmetry, its relation with age and its possible contribution to the risk of aortoiliac atherosclerosis are presented here. Statistical analysis was performed by SPSS version 11.0 using, Fisher`s exact test, the Pearson and Spearman correlation tests and logistic regression analysis. The p value was set at 0.05. No correlations were found between age, bifurcation angle and angle asymmetry in the Pearson test (p > 0.05). Logistic regression analysis revealed that the bifurcation angle, but not its asymmetry, gender or age, was a significant and independent risk factor for aortoiliac atherosclerosis (model r2 = 0.662, p = 0.027). With additional study these results may have implications regarding risk factors for aortoiliac atherosclerosis. To our knowledge, this study is the first of its kind to indicate the potential of such an important geometric risk factor for atherosclerosis at the aortic bifurcation

A complex dural-venous variation in the posterior cranial fossa: a triplicate falx cerebelli and an aberrant venous sinus

Variations of the dural folds and the dural venous sinuses are seldom reported in the extant medical literature. Such variations in the posterior cranial fossa may be problematic in various diagnostic and operative procedures of this region. We report our observation of an extremely rare variation of the falx cerebelli and posterior cranial fossa venous sinuses encountered upon dissection of a young male cadaver. In this specimen the falx cerebelli was duplicated with dimensions of 45.3 × 5.1 mm and 49.8 × 5.3 mm for the right and left falces respectively. The distance between the two falces was 3.2, 4.5 and 7.8 mm at their proximal, middle and distal thirds. An accessory small falx (31.8 × 2 mm) was also found approximately 3.4 mm lateral to the right falx cerebelli and blended with the lateral surface of the right falx cerebelli. There was only one occipital venous sinus (diameter, 2.5 mm) and no marginal sinus was detected. At the right floor of the posterior cranial fossa (posterolateral to the foramen magnum) an additional dural venous sinus was found, which connected the terminal portion of the right sigmoid sinus to the occipital and right transverse sinuses via one medial and two lateral branches respectively. We believe that such a complex dural-venous variation in the posterior cranial fossa has not previously been reported. Neurosurgeons and neuroradiologists should be aware of such variations, as these could be potential sources of haemorrhage during suboccipital approaches or may lead to erroneous interpretations of imaging of the posterior cranial fossa

Enamel matrix derivative Emdogain® as an adjuvant for a laterally-positioned flap in the treatment of gingival recession: an electron microscopic appraisal

Enamel matrix derivative (EMD), such as Emdogain®, has been suggested for the improvement of wound healing in periodontal surgical therapy. The present qualitative study seeks to illustrate the ultrastructural changes associated with a human gingival wound at 10 days after the application of EMD as an adjunct to a laterally-positioned flap in a patient with gingival recession. An otherwise healthy patient, who had been suffering from bilateral gingival recession defects on teeth #23 and #26, was studied. One defect was treated with a laterally-positioned flap, while the other was treated with a combination of EMD and a laterally-positioned flap. Ten days after the operation gingival biopsy specimens were obtained from the dentogingival region and examined using a transmission electron microscope. A considerable difference was found in both the cellular and extracellular phases of EMD and non-EMD sites. The fibroblasts of EMD site were more rounded with plump cytoplasms and euchromatic nuclei. A well-developed rough endoplasmic reticulum and numerous mitochondria could be detected. In contrast, the fibroblasts of non-EMD site were of flattened spindle-like morphology. While the signs of apoptosis could rarely be detected at EMD site, apoptotic bodies and ultra-structural evidence of apoptosis (crescent-like heterochromatic nuclei and dilated nuclear envelopes) were consistent features at non-EMD site. The extracellular matrix at EMD site mainly consisted of well-organised collagen fibres, while non-EMD site contained sparse and incompletely-formed collagen fibres. Coccoid bacteria were noted within the extracellular matrix and neutrophils at non-EMD site. It seems that EMD may enhance certain features of gingival wound healing, which may be attributable to its anti-apoptotic, anti-bacterial or anti-inflammatory properties

The ansa subclavia: a review of the literature

The ansa subclavia, subclavian loop, Vieussens’ ansa or Vieussens’ loop is a nerve cord that connects the middle cervical and inferior cervical sympathetic ganglia, forming a loop around the subclavian artery. The structure of the ansa subclavia is evolutionarily conserved from rats, guinea pigs, the porcine species and dogs to humans. A common application in physiological studies is to electrically stimulate the ansa subclavia in animal models as a robust protocol to modulate stimulatory cardiac sympathetic input. Despite a large number of physiological studies utilizing the ansa subclavia, only very brief descriptions have been devoted to it in standard anatomy texts. An extensive search found only one report in the English language literature concerning the anatomy of the ansa subclavia. The aim of this report, therefore, was to provide a comprehensive review of the clinical anatomy of the ansa subclavia and to discuss its potential physiological functions